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How alcohol contributes to thiamine deficiency Reduces intestinal absorption of thiamine Impairs hepatic storage and activation Increases metabolic demand in the context of oxidative stress and high carbohydrate intake (22) Common symptoms and clinical consequences of thiamine deficiency Fatigue and profound low energy Brain fog, poor concentration, and memory changes Mood instability, irritability, or depression Neuropathy, tingling, or burning sensations in the extremities In more severe cases, WernickeKorsakoff syndrome with confusion, ataxia, and vision changes Clinically, thiamine deficiency often shows up as mental exhaustionpatients describe feeling cognitively offline, overwhelmed, or unable to tolerate stress

PBMs also set the utilization controls that help balance access and affordability, such as prior authorization, step therapy, and BMI or diagnosis requirements for weight-management use

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Complex carbohydrates: White rice, plain pasta, potatoes without skin, bread